I am a highly ambitious and performance driven professional with an unparalleled work ethic with over 13 years of experience in Specialty health and Biopharmaceutical industry(Specialty medications and Patient support programs). Extensively knowledgeable in provincial, private and federal Drug Reimbursement processes throughout Canada with a working expertise in wide range of pharmaceutical products for various therapeutic areas.
Efficient in developing and leading formal account strategies that consistently delivers solutions that are integrated, synchronized and advantageous to the pharmaceutical manufacturers. With proven track record of efficiently leading the Program Management team to ensure operational execution and implementation.
Qualified with a exceptional blend of work and educational experiences, I am an enthusiastic, results-oriented professional that is always prepared to problem-solve through any challenge. With an inherent believer in continuous improvement, I strive to proactively identify and implement long term and short term strategies to facilitate positive outcomes for clients.
• Subject matter expert on Reimbursement within Clinical and Patient Services division
• Maintained a working knowledge of drug benefit and reimbursement schemes to maximize customer experience
• Provided assistance with patient reimbursement challenges including Benefit Applications, Prior Authorization and Appeals
• Facilitated the resolution utilizing relationship contacts, negotiations and skills
• Worked in collaboration with multiple key stakeholders (Drug manufactures, payers, physicians, government etc.)
• Maintain market intelligence on Public and private payer markets
• Ensure that all the call center staff is adhering to the Reimbursement best practices
• Authored and maintained program specific and corporate wide Reimbursement work instructions
• Participated in annual and quarterly client Business review
• Participated in RFP’s on reimbursement requirements
• Performed complete Case management for PSPs
• Organized meetings with KOL’s for smooth running of the program.
• Assisted team with complex reimbursement cases to maximize the reimbursement solutions
• Led refresher training for new hires
• Prepared detailed training binders for associates to follow for day to day work
• Worked on different drug and disease states for the Inspiration program
• Maintained detailed reimbursement navigation with Public, private and federal bodies.
• Arranged financial/travel assistance for the patients as needed after through reimbursement navigation.
• Managed the reimbursement and provided health case management for various indications (Rheumatoid Arthritis, Multiple Sclerosis, Growth deficiency, Cystic Fibrosis, Dermatology and Nephrology conditions etc.) all across Canada.
• Co-coordinated and managed all aspects required in order to obtain prescription drug coverage through Public/Federal funding programs, private insurance companies.
• Co-coordinated cases with insurance companies, physician’s offices and healthcare professionals in order to maximize reimbursement solutions.
• Led refresher training and On-boarded new hires
• Followed appeal procedures, explored compassionate access to the drug as a last option.
• Completed case management of the assigned cases including intake, enrollment, reimbursement navigation, patient education and on-going drug monitoring.
• Administered and adhered to case management protocols, including clinical monitoring, data collection, on-going patient follow up, compliance, therapy disruption/discontinuation monitoring, adverse event reporting.
• Completed pre-infusion checklists and baseline assessments with patients and seek nursing opinion, medical clarifications from physicians as needed.
• Acted as a liaison with primary health care providers.
• Visited the Hospitals regularly to meet with the physicians, nurses, helped them to navigate reimbursement processes in order to facilitate easy access to the drug for their patients.
• Detailed reimbursement navigation with Public, private and federal bodies.
• Ordered and Co-ordinated the drug delivery from the patient specific pharmacy for it to arrive on time for the patient’s infusion.
• Arranged financial/travel assistance for the patients as needed after through reimbursement navigation.
• Provided coaching and medical information to the patients on the new drug.
• Managed the reimbursement and provided health case management for various indications (Rheumatoid Arthritis, Multiple Sclerosis, Growth deficiency, Cystic Fibrosis, Dermatology and Nephrology conditions etc.) all across Canada.
• Co-coordinated and managed all aspects required in order to obtain prescription drug coverage through Public/Federal funding programs, private insurance companies.
• Co-coordinated cases with insurance companies, physician’s offices and healthcare professionals in order to maximize reimbursement solutions.
• Developed and prepared private and public payer submissions.
• Completed overall case management of the patients, implemented financial means/travel assistance requests, monitored their treatment while on drug.
• Handled a large case load of patients including Alberta, British Columbia, Saskatchewan, Manitoba and Atlantic provinces
• Arranged Compassionate access to the drug incase all avenues fail for reimbursement.
• Handled mini projects of converting patients from trial medications to provincial funding as soon as the drug listed on the formulary by the provincial body.
• Completed manual and computerized patient scheduling (initial assessment, re-assessment, treatment appointments), entered patient information, explained insurance coverage’s.
• Explained patient assessment procedures to new patients and completed the appropriate forms (Private/Motor Vehicle Accident or work-related WSIB).
• Tracked and monitored MVA/WSIB cases, followed-up with case managers and claims adjustors as required and updated patient’s file and their doctors/therapists accordingly.
• Completed weekly and monthly statistics on # of patient visits, income and expenses.
• Lead refresher training and On-boarded new hires.
• Effectively interacted with a diverse patient population and insurance companies.
• Worked with funding agency guidelines, invoiced patients and dispatched the invoices for EHP/MVA/WSIB providers’ patients.